This is a rapid publication site that replaces Virtual Grand Rounds in Dermatology (vgrd.org). Please join and feel free to post cases. You can share the URL with friends. Since 2000, VGRD has been a valuable means to share cases in real time from one's home or office. "AND GLADLY WOLDE HE LERNE AND GLADLY TECHE" has served as an enduring and inspirational motto. For more information, see the "About Page."

Monday, October 16, 2017

The patient is a 37 year old woman with a four year history of a slowly progressively asymptomatic area of induration on the posterior aspect of the left thigh (photo). A biopsy showed thickened collagen bundles in the reticular dermis and a sparse superficial and deep lymphoplasmacytic infiltrate consistent with morphea.Strangely, her father-in-law is seriously ill with systemic sclerosis. He lives far from the patient and her husband. At this time, we have discovered no common exposures the patient and her father-in-law have. The patient lives in an endemic area for Lyme Disease and serological testing will be offered.

Questions:Is there any value in obtaining serologies, other than Lyme studies, on this woman?What treatment might be of value? Do you have alternate diagnoses?

3. "Borrelia-associated early-onset morphea": a
particular type of scleroderma in childhood and adolescence with high titer
antinuclear antibodies? Results of a cohort analysis and presentation of three
cases.

Prinz JC, et. al. J Am Acad Dermatol. 2009 Feb;60(2):248-55. CONCLUSION:B burgdorferi infection may be relevant for the induction of a distinct autoimmune type of scleroderma; it may be called "Borrelia-associated early onset morphea"
and is characterized by the combination of disease onset at younger
age, infection with B burgdorferi, and evident autoimmune phenomena as
reflected by high-titer antinuclear antibodies. As exemplified by the
case reports, it may take a particularly severe course and require
treatment of both infection and skin inflammation.